Comportamento sexual e uso de álcool e drogas entre homens que fazem sexo com homens no Ceará: tendências e práticas de risco para DST/AIDS

Abstract

In Brazil, cases of AIDS amonf men who make sex with men (MSM) predominated durinf a long period, but declined in the 90s as an increase was observed among heterosexual persons. In the Northeast Brazil, however, AIDS casis among MSM still account for 50% of all casis reportedrecently. To study the sexual behavior and patterns of alcohol and ilicit drugs consumption in Ceará, Brazil, emphasizing recent trends and their relation with risky sexual practices to STD/AIDS. Four surveys were carried out in the years of 1995, 1998, 2002 and 2005 in Ceará, Northeast Brazil. Study population included MSM of 14 years old or above reporting anal sex in the last 12 months. Different selection techniques were employed: Snow Ball (1995, 1998, 2002); Time Spaces Sampling (2002) and Respondent Driven Sampling (2005). The first manuscript focuses on the recent trends of sexul behvior of MSM in Fortaleza, and the scond evaluates the predictors of alcohol and drug sonsumtion in the cities of Fortaleza (n=401), Sobral (n= 100) and the region of Cariri (n=100) in the year of 2002. Analyses were based on th comparison between proportions (Pearson test and 95 % confidence intervals CI95%, as the measure of association between putative risk factors and alcohol and drug use. Sexual practices: high percentual percentage or risky sexual practices was reported in 1995 (49.9%), decreasing in 1998 (32.6%), increasing again in 2002 (54.6%) and presenting the lowest percentages in 2005 (31.4%). This pattern did not vary with age. Those participants with higher literacy increased their risky practices from 1998 (28.6%) to 2002 (46.5%), decreasing in the lastperiod (21.0%). Among those with middle or low levels risky behavior declined from 2002 (82.1% - low; 67.7% - middle) to 2005 (29.1% - low; 34.3% - middle). We observed an increase of anal sex with condom between the first and the last wave (43.3% to 53.7% for trens p< 0.001). Anal sex without condom was very commom inmost of the years. Between 2002 and 2005 there was a decrease in monogamous stable relationship (from 57.7% to 26, and 3%). Alcohol and drug consumption: 63% of the MSM participants were classified as (binge drinking) drinkers.Increased consumption of alcohol was associated with an increase in the simultaneous use of other licit and illicit drugs. The predict onnected with (binge dronking) drinking were: age, 21-30 vs. <21 years old (OR: 1.5; CI95%: 1,1-2.9); >30 vs. <21 years old (OR: 1.6; CI95%: 1.2-2.3); civil status, being single/ separated/divorced vs. married/together (OR: 3.9; CI95%: 1.7-5.3); race, being clack vs. white (OR: 5.9; CI95%: 1.7-20.1); being mixed vs. white (OR: 1.8; 95% CI: 1.3-2.6); getting paid for sex (OR: 2.0; CI 95%: 1.4-3.0); having had an HIV test (OR: 1.7; CI95%: 1.3-2.2); family disapproval of MSM (OR: 1.4; CI95%: 1.1-1.9); using vs. not using any drug (OR: 2.3; CI95%: 1.8-29). The sexuak practices of MSM in Fortaleza varied significantly over the studied years, something also observed in other international studies. Many local, national and international contextual factors might be responsible for this trend: 1) reduction in financial resources for AIDS prevention in Brazil due to new priorities of internationak organizations, now focusing African and East European countries. This have led Brazil to give priority to more vulnerable segments of the population than MSM; 2) high impact of STD/AIDS prevention initiatives among homo / bisexual males, particularly in the years of 1998 and 2002; 3) the advances in treatment, leading to better quality of life and survival prespective, wich may have contributed to a false idea of security in this population. In our study, literacy was an important factor assicated to risky sexual behavior. Participants with low levels of education, during 1995 to 2002, were engaged in more risky practices, apparently not taking benefit of public health campaigns occurring mainly during 11995 and 1998. Higher literacy was a protective factor during all studied period and might be, in this setting, a proxy for access to information. Finally, we could observe in the year of 2002 an elevated percentage of MSM that use five or more alcohol doses in a typical working day and that associate the use of other drugs with alcohol consumption. This behavior among MSM, although not characterized as dependence, might favor sexual risky practices. We also observed that increasing alcohol consumption was associated with the use of other drugs, contributing to the adoption of other risky behavior. Participants that report taking money for sex were more frequently classified as (binge drinking) drinkers. The results of this study highlight the need of a continuous behavioral surveillance for HIV to better understand the dynamics of the epidemic among MSM and to inform STD and HIV prevention programs. The findings of this study show also the importance of alcohol abuse as a public health problem in this specific population and the need for specific prevention measures.